How it is administered

Elranatamab is given as a subcutaneous injection, which means it is injected under the skin. It is available in single-dose vials at a concentration of 40 mg/mL, supplied as either 76 mg/1.9 mL or 44 mg/1.1 mL vials.

The recommended dosing schedule involves a step-up dosing phase to help reduce the risk of side effects:

• Day 1: 12 mg (step-up dose 1)
• Day 4: 32 mg (step-up dose 2)
• Day 8: 76 mg (first full treatment dose)

After this, the patient receives 76 mg weekly through week 24. If the patient responds to treatment and maintains the response for at least 2 months, the dosing interval may be extended to every 2 weeks, and eventually every 4 weeks if the response is maintained.

How it works

Elranatamab is a type of immunotherapy known as a bispecific antibody. It is designed to help your immune system target and destroy cancer cells in multiple myeloma, a type of blood cancer.

Elranatamab works by binding to two different proteins: BCMA (B-cell maturation antigen), which is found on the surface of multiple myeloma cells, and CD3, which is found on T-cells (a type of immune cell). By bringing T-cells into close contact with myeloma cells, elranatamab helps activate the T-cells to attack and kill the cancer cells. This process can also lead to the release of substances called cytokines, which help coordinate the immune response but can also cause side effects.

This targeted approach allows the immune system to focus its attack on the cancer cells, potentially leading to better outcomes for patients with relapsed or refractory multiple myeloma.

Who Should take it

Elranatamab is intended for adults with relapsed or refractory multiple myeloma who have already received at least four prior lines of therapy. These previous treatments should have included a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

This medication is approved under an accelerated program based on how well it works and how long the response lasts. It is specifically for patients whose disease has come back or has not responded to other available treatments. Your doctor will determine if elranatamab is appropriate for you based on your treatment history and current health status.

Who should not take it

There are currently no absolute contraindications listed for elranatamab. However, it should not be started in patients with active infections. Patients should also inform their healthcare provider if they are pregnant, planning to become pregnant, or breastfeeding, as elranatamab may cause harm to an unborn baby and is not recommended during pregnancy or breastfeeding.

Additionally, caution is advised in patients with severe liver or kidney impairment, as the effects in these populations are not fully known. Always discuss your full medical history and any current medications with your healthcare provider before starting elranatamab.

Commonly used with

Elranatamab is typically used as a single agent in patients with relapsed or refractory multiple myeloma who have already tried several other treatments. It is not commonly combined with other anti-myeloma drugs, but your healthcare provider may prescribe supportive medications such as:

• Acetaminophen (to reduce fever)
• Dexamethasone (to reduce inflammation and risk of side effects)
• Diphenhydramine (to reduce allergic reactions)

These are given before elranatamab doses, especially during the initial step-up phase, to help minimize the risk of cytokine release syndrome.

Commonly tested with

In clinical trials, elranatamab has been studied mainly as a single agent for patients with relapsed or refractory multiple myeloma. Patients in these studies had previously received other types of treatments, including proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies.

Ongoing and future studies may explore its use in combination with other therapies, but current data for blood cancers focus on its use alone in heavily pre-treated multiple myeloma patients.